The Correlation between Presenting Features and Surgical Outcomes in Pediatric Cholesteatoma

Abstract

Objectives:

Determine how presenting features of cholesteatoma in children influence surgical outcome.

Methods:

A prospective database of 319 consecutive children with cholesteatoma was analyzed to compare features of cholesteatoma at presentation with patient-focused outcome measures. Features of disease included the presence of otorrhea, hearing loss (mean 4 tone air conduction audiogram more than 30dB HL), the type and extent of cholesteatoma, and ossicular status. Outcomes included hearing threshold, number of surgeries, and canal wall preservation. Cases with cholesteatoma surgery or tympanoplasty prior to referral were excluded.

Results:

Of 200 children with cholesteatomas, 32 ears presented with congenital lesions and 178 ears presented with acquired lesions. The mean age at diagnosis was 6.6 years for congenital and 11.5 years for acquired cholesteatoma. A history of continuous otorrhea had a sensitivity of 0% for diagnosis of congenital cholesteatoma and 37% for acquired. Hearing loss had a sensitivity of 57% for congenital and 72% for acquired cholesteatoma. The canal wall was preserved in 181 (86%) ears at first surgery. Mean hearing level was unchanged after surgery at 36dB HL. More extensive cholesteatoma correlated with more ossicular erosion, more canal wall down surgery, worse postoperative hearing, and more repeated surgeries (P < 0.05; multiple regression analysis).

Conclusions:

Better outcomes for children with cholesteatoma can be achieved by early identification and surgery when lesions are smaller. As cholesteatoma can be relatively silent in children, without otorrhea or hearing loss. Physicians must be trained to identify otoscopic features of congenital and acquired cholesteatoma and initiate prompt referral.